Dual wedge expandable implant with eyelets, system, and method of use

ABSTRACT

An expandable implant movable between a contracted position and an expanded position, is disclosed. In various embodiments, the implant may include a superior endplate and an inferior endplate having proximal ramps and distal ramps disposed on an interior surface thereof, respectively. In various embodiments, a proximal set screw and a distal set screw may be independently coupled to a proximal wedge and a distal wedge. Upon rotation of the proximal set screw, the proximal wedge may act against the proximal ramps of the superior and inferior endplates and cause the implant to expand at the proximal end. Upon rotation of the distal set screw, the distal wedge may act against the distal ramps of the superior and inferior endplates and cause the implant to expand at the distal end. In some embodiments, a first eyelet and a second eyelet for supporting a corresponding bone screw, respectively, may be included.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation in part of U.S. patent applicationSer. No. 17/331,058, titled DUAL WEDGE EXPANDABLE IMPLANT, SYSTEM ANDMETHOD OF USE, filed May 26, 2021 and U.S. patent application Ser. No.17/391,158, titled DUAL EXPANDING SPINAL IMPLANT, SYSTEM, AND METHOD OFUSE, filed Aug. 2, 2021 which are both continuation in part applicationsof U.S. patent application Ser. No. 17/123,889, titled EXPANDABLEINTER-BODY DEVICE, SYSTEM, AND METHOD, filed Dec. 16, 2020 which claimspriority to and incorporates by reference co-related internationalpatent applications, PCT/IB2020/000942, titled Expandable Inter-BodyDevice, System, and Method, filed Nov. 5, 2020; and PCT/IB2020/000953,titled Expandable Inter-Body Device, System, and Method, filed Nov. 5,2020. The contents of each above application are hereby incorporated byreference in their entireties.

FIELD

The present disclosure generally relates to medical devices for thetreatment of musculoskeletal disorders, and more particularly to asurgical device that includes an expandable spinal implant, systems forimplanting and manipulating the expandable spinal implant, and a methodfor treating a human spine. In some embodiments, disclosed implants maybe used in an anterior cervical discectomy and fusion (ACDF) procedurealthough other uses in other areas of the spine or for other orthopedicapplications are also contemplated.

BACKGROUND

Spinal disorders such as degenerative disc disease, disc herniation,osteoporosis, spondylolisthesis, stenosis, scoliosis and other curvatureabnormalities, kyphosis, tumor, and fracture may result from factorsincluding trauma, disease and degenerative conditions caused by injuryand aging. Spinal disorders typically result in symptoms including pain,nerve damage, and partial or complete loss of mobility.

Non-surgical treatments, such as medication, rehabilitation and exercisecan be effective; however, they may fail to relieve the symptomsassociated with these disorders. Surgical treatment of these spinaldisorders includes fusion, fixation, correction, discectomy, laminectomyand implantable prosthetics. As part of these surgical treatments,spinal constructs, such as, for example, bone fasteners, spinal rods andinterbody devices can be used to provide stability to a treated region.For example, during surgical treatment, interbody devices may beintroduced to a space between adjacent vertebral bodies (the interbodyspace) to properly space the vertebral bodies and provide a receptaclefor bone growth promoting materials (BGM), e.g., bone graft and/orsynthetic materials.

Mechanically operated interbody implants may be used to align and/orrealign a patient's spine during a medical procedure. Conventionalimplants designed for the Thoracic and Lumbar region of the spine ofteninclude top and bottom endplates and a mechanical means to separate thetop and bottom endplates. The mechanical mechanisms to separate the topand bottom endplates are often cumbersome and require a large footprintthat is often unsuitable for ACDF type surgeries of the cervical portionof the spine.

SUMMARY

The techniques of this disclosure generally relate, for example, tohighly adjustable interbody devices that are expandable to selectivelyincrease and decrease a spacing distance between superior and inferiorendplates of the interbody device at either or both of a proximal endand/or a distal end of the implant.

In one aspect, an expandable implant movable between a contractedposition and an expanded position, is disclosed. The implant mayinclude, an expandable body extending from a proximal end to a distalend in a proximal-to-distal direction, extending from a first lateralside to a second lateral side in a widthwise direction, and extendingfrom a superior end to an inferior end in a vertical direction, forexample. In various embodiments, the expandable body may be defined by asuperior endplate and an inferior endplate opposite the superiorendplate, for example. In various embodiments, the superior endplate mayinclude a first outside surface and a first inside surface opposite thefirst outside surface, the first inside surface may include firstproximal ramps and first distal ramps disposed opposite the firstproximal ramps, for example. In various embodiments, the inferiorendplate may include a second outside surface and a second insidesurface opposite the second outside surface, the second inside surfacemay include second proximal ramps and second distal ramps disposedopposite the second proximal ramps, for example. In various embodiments,a support block may be coupled to the superior endplate and the inferiorendplate, the support block may have a proximal screw guide and a distalscrew guide opposite the proximal screw guide, for example. In variousembodiments, a proximal set screw rotatably supported by the proximalscrew guide and a distal set screw rotatably supported by the distalscrew guide may be provided, for example. In various embodiments, aproximal wedge may include first superior ramped surfaces and firstinferior ramped surfaces, the proximal wedge may be coupled to theproximal set screw; and a distal wedge may include second superiorramped surfaces and second inferior ramped surfaces, the distal wedgemay be coupled to the distal set screw, for example. In someembodiments, at least one eyelet may be disposed on a proximal end ofthe expandable body. In other embodiments, at least two eyelets may bedisposed on opposite lateral ends of the expandable body. In variousembodiments, in a contracted position the proximal wedge and the distalwedge are disposed in a medial position of the body, for example.Additionally, in some embodiments, in a first expanded position aspacing between the superior and inferior endplates at the proximal sideis greater than a spacing between the superior and inferior endplates atthe proximal side in the contracted position, in the first expandedposition the proximal wedge may contact the first superior rampedsurfaces and the first inferior ramped surfaces and is disposedproximate the proximal side, for example. Additionally, in someembodiments, in a second expanded position a spacing between thesuperior and inferior endplates at the distal side is greater than aspacing between the superior and inferior endplates at the distal sidein the contracted position, in the second expanded position the distalwedge may contact the first and second proximal ramps and is disposedproximate the proximal side with respect to the medial position, forexample.

In another aspect, a spinal implant system is disclosed. The spinalimplant system may include an expandable implant movable between acontracted position and an expanded position. The implant may include,an expandable body extending from a proximal end to a distal end in aproximal-to-distal direction, extending from a first lateral side to asecond lateral side in a widthwise direction, and extending from asuperior end to an inferior end in a vertical direction, for example. Invarious embodiments, the expandable body may be defined by a superiorendplate and an inferior endplate opposite the superior endplate, forexample. In various embodiments, the superior endplate may include afirst outside surface and a first inside surface opposite the firstoutside surface, the first inside surface may include first proximalramps and first distal ramps disposed opposite the first proximal ramps,for example. In various embodiments, the inferior endplate may include asecond outside surface and a second inside surface opposite the secondoutside surface, the second inside surface may include second proximalramps and second distal ramps disposed opposite the second proximalramps, for example. In various embodiments, a support block may becoupled to the superior endplate and the inferior endplate, the supportblock may have a proximal screw guide and a distal screw guide oppositethe proximal screw guide, for example. In various embodiments, aproximal set screw rotatably supported by the proximal screw guide and adistal set screw rotatably supported by the distal screw guide may beprovided, for example. In various embodiments, a proximal wedge mayinclude first superior ramped surfaces and first inferior rampedsurfaces, the proximal wedge may be coupled to the proximal set screw;and a distal wedge may include second superior ramped surfaces andsecond inferior ramped surfaces, the distal wedge may be coupled to thedistal set screw, for example. In various embodiments, in a contractedposition the proximal wedge and the distal wedge are disposed in amedial position of the body, for example. Additionally, in someembodiments, in a first expanded position a spacing between the superiorand inferior endplates at the proximal side is greater than a spacingbetween the superior and inferior endplates at the proximal side in thecontracted position, in the first expanded position the proximal wedgemay contact the first superior ramped surfaces and the first inferiorramped surfaces and is disposed proximate the proximal side, forexample. Additionally, in some embodiments, in a second expandedposition a spacing between the superior and inferior endplates at thedistal side is greater than a spacing between the superior and inferiorendplates at the distal side in the contracted position, in the secondexpanded position the distal wedge may contact the first and secondproximal ramps and is disposed proximate the proximal side with respectto the medial position, for example. Additionally, in variousembodiments, the support block may further include a plurality ofengagement prongs extending towards the proximal end in theproximal-to-distal direction, for example. Additionally, the system mayinclude an insertion tool extending in a longitudinal direction from aproximal end to a distal end thereof, and the insertion tool may includea plurality of engagement arms that may have a size and shapecorresponding to the plurality of engagement prongs, for example.

In another aspect, a spinal implant system is disclosed. The spinalimplant system may include an expandable implant and a bone screwdriving tool. The expandable implant may be movable between a contractedposition and an expanded position. The implant may include, anexpandable body extending from a proximal end to a distal end in aproximal-to-distal direction, extending from a first lateral side to asecond lateral side in a widthwise direction, and extending from asuperior end to an inferior end in a vertical direction, for example. Invarious embodiments, the expandable body may be defined by a superiorendplate and an inferior endplate opposite the superior endplate, forexample. In various embodiments, the superior endplate may include afirst outside surface and a first inside surface opposite the firstoutside surface, the first inside surface may include first proximalramps and first distal ramps disposed opposite the first proximal ramps,for example. In various embodiments, the inferior endplate may include asecond outside surface and a second inside surface opposite the secondoutside surface, the second inside surface may include second proximalramps and second distal ramps disposed opposite the second proximalramps, for example. In various embodiments, a support block may becoupled to the superior endplate and the inferior endplate, the supportblock may have a proximal screw guide and a distal screw guide oppositethe proximal screw guide, for example. In various embodiments, aproximal set screw rotatably supported by the proximal screw guide and adistal set screw rotatably supported by the distal screw guide may beprovided, for example. In various embodiments, a proximal wedge mayinclude first superior ramped surfaces and first inferior rampedsurfaces, the proximal wedge may be coupled to the proximal set screw;and a distal wedge may include second superior ramped surfaces andsecond inferior ramped surfaces, the distal wedge may be coupled to thedistal set screw, for example. In various embodiments, in a contractedposition the proximal wedge and the distal wedge are disposed in amedial position of the body, for example. Additionally, in someembodiments, in a first expanded position a spacing between the superiorand inferior endplates at the proximal side is greater than a spacingbetween the superior and inferior endplates at the proximal side in thecontracted position, in the first expanded position the proximal wedgemay contact the first superior ramped surfaces and the first inferiorramped surfaces and is disposed proximate the proximal side, forexample. Additionally, in some embodiments, in a second expandedposition a spacing between the superior and inferior endplates at thedistal side is greater than a spacing between the superior and inferiorendplates at the distal side in the contracted position, in the secondexpanded position the distal wedge may contact the first and secondproximal ramps and is disposed proximate the proximal side with respectto the medial position, for example. Additionally, in variousembodiments, the support block may further include a plurality ofengagement prongs extending towards the proximal end in theproximal-to-distal direction, for example. Additionally, the system mayinclude an insertion tool extending in a longitudinal direction from aproximal end to a distal end thereof, and the insertion tool may includea plurality of engagement arms that may have a size and shapecorresponding to the plurality of engagement prongs, for example. Invarious embodiments, the bone screw driver comprises a handle portionand a drive portion disposed at a distal end of the handle portion, thedrive portion further including a ratcheting mechanism, for example.

The details of one or more aspects of the disclosure are set forth inthe accompanying drawings and the description below. Other features,objects, and advantages of the techniques described in this disclosurewill be apparent from the description and drawings, and from the claims.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1A is a front perspective view of an expandable implant.

FIG. 1B is an alternate front perspective view of an expandable implant.

FIG. 2 is a top down view of an expandable implant.

FIG. 3 is a front perspective view of an expandable implant.

FIG. 4 is an alternate front perspective view of an expandable implant.

FIG. 5 is an exploded parts view of an expandable implant.

FIG. 6 is an alternate exploded parts view of an expandable implant.

FIG. 7 is an interior view of a superior endplate.

FIG. 8 is an alternate interview of a superior endplate.

FIG. 9 is an interior view of an inferior endplate.

FIG. 10 is an alternate interview of a inferior endplate.

FIG. 11 is a front perspective view of a superior portion of expandableimplant.

FIG. 12 is a front perspective view of an inferior portion of expandableimplant.

FIG. 13 is a front perspective view of an expandable implant in a firstexpanded configuration.

FIG. 14 is an alternate front perspective view of an expandable implantin a first expanded configuration.

FIG. 15 is a front perspective view of an expandable implant in a secondexpanded configuration.

FIG. 16 is an alternate front perspective view of an expandable implantin a second expanded configuration.

FIG. 17 is a perspective view of a cross section cut of an expandableimplant in a contracted configuration.

FIG. 18 is a perspective view of a cross section cut of an expandableimplant in an expanded configuration.

FIG. 19 is a perspective view of a cross section cut of an expandableimplant in an expanded configuration.

FIG. 20 is a perspective view of a cross section cut of an expandableimplant in an expanded configuration.

FIG. 21 is a perspective view of an inserter tool for use with disclosedexpandable implants.

FIG. 22 is a perspective view of an inserter tool for use with disclosedexpandable implants.

FIG. 23 is a perspective view of an inserter tool for use with disclosedexpandable implants.

FIG. 24A is a perspective view of an inserter tool for use withdisclosed expandable implants.

FIG. 24B is a perspective view of a distal region of an inserter toolfor use with disclosed expandable implants.

FIG. 25 is a perspective view of an inserter tool coupled to anexpandable implant.

FIG. 26 is a perspective view of an inserter tool and a driver tool foruse with disclosed expandable implants.

FIG. 27 is a perspective view of a drive tool for use with disclosedexpandable implants.

FIG. 28A is an enlarged view of a proximal end of an inserter tool in anunlocked position.

FIG. 28B is an enlarged view of a proximal end of an inserter tool in alocked position.

FIG. 29 is a cross section cut showing an inserter tool and a drive tooloperably engaged with an expandable implant.

FIG. 30 is a cross section cut showing an inserter tool and a drive tooloperably engaged with an expandable implant.

FIG. 31 is a perspective view of an alternate drive tool for use withdisclosed expandable implants.

FIG. 32 is a cross section cut of the alternate drive tool of FIG. 31engaged with an expandable implant.

FIG. 33 is a cross section cut of an inserter tool and an example methodof use of the inserter tool.

FIG. 34 is a reference drawing showing the human spine of which variousdisclosed implant embodiments may be installed in.

FIG. 35 is a reference drawing showing various planes and referencedirections of which the various disclosed implant embodiments may movein or act in.

FIG. 36 is a front perspective view of expandable implant.

FIG. 37 is a front perspective view of an expandable implant and asuperior bone screw and inferior bone screw.

FIG. 38 is a top down view of an expandable implant.

FIG. 39A is a front view of an expandable implant showing various bonescrew trajectories.

FIG. 39B is a top down view an expandable implant showing various bonescrew trajectories.

FIG. 40 is a front view of an expandable implant positioned between asuperior vertebrae and an inferior vertebrae.

FIG. 41 is a perspective view of a bone screw driver.

FIG. 42 is a partially removed parts view of a tip region of the bonescrew driver of FIG. 41.

FIG. 43A illustrates a first aspect of an installation procedureutilizing an expandable implant and a bone screw driver.

FIG. 43B illustrates a second aspect of an installation procedureutilizing an expandable implant and a bone screw driver.

FIG. 43C illustrates a third aspect of an installation procedureutilizing an expandable implant and a bone screw driver.

FIG. 43D illustrates a fourth aspect of an installation procedureutilizing an expandable implant and a bone screw driver.

FIG. 44 illustrates a front perspective view of a bone screw plate foruse with disclosed expandable implants.

FIG. 45 illustrates an alternate front perspective view of a bone screwplate for use with disclosed expandable implants.

FIG. 46 illustrates a top down view of a bone screw plate.

FIG. 47 illustrates an exploded parts view of a bone screw plate.

FIG. 48 illustrates a front perspective view of a bone screw platesecurely coupled to an expandable implant.

FIG. 49 illustrates a front view of a bone screw plate securely coupledto an expandable implant.

FIG. 50 illustrates a top down view of a bone screw plate securelycoupled to an expandable implant.

DETAILED DESCRIPTION

Embodiments of the present disclosure relate generally, for example, tospinal implants, spinal stabilization systems, surgical instruments foruse with spinal stabilization systems, and more particularly to spinalimplants having eyelets. Embodiments of the devices and methods aredescribed below with reference to the Figures.

The following discussion omits or only briefly describes certaincomponents, features and functionality related to medical implants,installation tools, and associated surgical techniques, which areapparent to those of ordinary skill in the art. It is noted that variousembodiments are described in detail with reference to the drawings, inwhich like reference numerals represent like parts and assembliesthroughout the several views, where possible. Reference to variousembodiments does not limit the scope of the claims appended heretobecause the embodiments are examples of the inventive concepts describedherein. Additionally, any example(s) set forth in this specification areintended to be non-limiting and set forth some of the many possibleembodiments applicable to the appended claims. Further, particularfeatures described herein can be used in combination with otherdescribed features in each of the various possible combinations andpermutations unless the context or other statements clearly indicateotherwise.

Terms such as “same,” “equal,” “planar,” “coplanar,” “parallel,”“perpendicular,” etc. as used herein are intended to encompass a meaningof exactly the same while also including variations that may occur, forexample, due to manufacturing processes. The term “substantially” may beused herein to emphasize this meaning, particularly when the describedembodiment has the same or nearly the same functionality orcharacteristic, unless the context or other statements clearly indicateotherwise.

Referring generally to FIGS. 1-4 various views of an expandable implantare illustrated. For example, FIGS. 1A-1B and 3-4 are variousperspective views of an expandable implant 100 and FIG. 2 is a top downview of an expandable implant showing various axes and points ofreference. As illustrated, expandable implant 100 may include a proximalend 100 p, a distal end 100 d, and first and second lateral sides 100 l.The proximal end 100 p may include an adjustment aperture 101 and anengagement cutout 103 for use with various surgical tools disclosed inFIGS. 21-33. As shown in FIG. 2, implant 100 may extend in aproximal-to-distal direction from the proximal end 100 p to the distalend 100 d though axis P-D through the center of the implant 100, forexample. Implant 100 may extend in a widthwise direction from the firstlateral side 100 l to the second lateral side 100 l through a widthwiseaxis W-W through the center of the implant 100, for example. Axis P-Dmay be perpendicular and/or substantially perpendicular to the widthwiseaxis B-B. Various example section cuts through cross section C-C areillustrated in FIGS. 17-20. In various embodiments, superior endplate 10may include connection points 11 and inferior endplate 20 may includeconnection points 21. Connection points 11, 21 may be indentations alongthe proximal end of each of superior and inferior endplates 10, 20, forexample. In various embodiments, connection points 11, 21 may be used tosecure a bone screw plate (not illustrated) and the bone screw plate mayinclude various apertures and fasteners for securing bone screws to aboney structure, such as a vertebrae. Superior endplate 10 may include afirst slot 13 and a second slot 14 on opposite lateral ends thereof, forexample. Similarly, inferior endplate 20 may include a third slot 23 anda fourth slot 24 on opposite lateral ends thereof, for example. Slots13, 14, 23, 24 may be used to constrain a support block 30 (see FIG. 5)within the interior of the superior and inferior endplates 10, 20. Adistal side of superior endplate 10 may include a curved indentation 16for accommodating the spinal canal. Similarly, inferior endplate 20 mayinclude a curved indentation 26 for accommodating the spinal canal. Thecurved indentations may be curved inward towards a medial portion ofimplant (e.g., from a distal end 100 d towards a proximal end 100 p) andextend in the width wise direction W-W, for example.

FIGS. 5-6 are various exploded parts views of an expandable implant 100.The superior and inferior endplates 10, 20 may be movable with respectto one another in the vertical direction and also may be inclinable,e.g., capable of distraction and lordosis and even kyphotic adjustments.The superior endplate 10 and inferior endplate 20 may be operablyengaged and/or coupled with one another by a support block 30, forexample. Support block 30 may include a first post 34 and a second post33 on each lateral side surface of support block 30. For example, firstpost 34 may be an elongate cylindrical post extending in the widthwisedirection W-W from support block and second post 33 may be a relativelyshorter elongate cylindrical post extending in the widthwise direction,for example. Additionally in some embodiments, post 34 and post 33 mayhave an inclined end cap having a planar end surface approximating theshape of an oval. Similarly, the other lateral side of support block 30may also include a first post 34 and a second post 33. In someembodiments, the posts 34, 33 on opposite lateral ends may betransposed. For example, on a first lateral end, post 34 may be abovepost 33 and on the other lateral end post 33 may be above post 34. Thisarrangement may facilitate the symmetrical transference of forcesthroughout implant 100, for example. Additionally, posts 34 may extendthrough slotted apertures 14, 24 of superior and inferior endplates 10,20, for example. Similarly, posts 33 may extend through slottedapertures 13, 23 of superior and inferior endplates 10, 20, for example.

Support block 30 may include a plurality of engagement prongs 32 or postlike structures extending towards proximal end 100 p. In the exampleillustration, four engagement prongs 32 are symmetrically distributed atrespective corners of a proximal end of support block 30. However, otherembodiments may include more or less engagement prongs 32, for example,1, 2, 3, 5, 6, etc. Engagement prongs 32 may be used to couple implant100 to an inserter tool 200, as will be explained in further detailbelow. Support block 30 may include a proximal screw guide 31 p and adistal screw guide 31 d. The proximal and distal screw guides 31 p, 31 dmay each be defined by a circular aperture having an internalcircumferential surface including a thread pattern and define a rotationaxis extending through a center of the thread pattern, respectively. Insome embodiments, the thread patterns may be reversed and in otherembodiments they may be the same. The proximal screw guide 31 p mayrotatably support a proximal set screw 40 and the distal screw guide 31d may rotatably support a distal set screw 50, for example. The proximalset screw 40 may include a thread pattern 41 extending along a portionof the outside circumferential surface thereof and a drive engagementsurface 43 extending along a portion of the inside circumferentialsurface thereof. A remaining portion of the outside circumferentialsurface thereof may be defined by a diameter that is less than adiameter of the portion of set screw 40 having thread pattern 41, forexample. For example, a smooth circumferential surface 44 that is insettowards an axial centerline of set screw 40 and with respect to threadpattern 41. For example still, one end of set screw 40 may include athread pattern 41 and the other end may include an inset circumferentialsurface 44 having at least one flange 42 on an end thereof. In someembodiments, an upper and lower flange 42 are provided, and in otherembodiments the flange 42 extends all the way around the end ofcircumferential surface 44 as an annular ring. Similarly, the distal setscrew 50 may include a thread pattern 51 extending along a portion ofthe outside circumferential surface thereof and a drive engagementsurface 53 extending along a portion of the inside circumferentialsurface thereof. A remaining portion of the outside circumferentialsurface thereof may be defined by a diameter that is less than adiameter of the portion of set screw 50 having thread pattern 51, forexample. For example, a smooth circumferential surface 54 that is insettowards an axial centerline of set screw 50 with respect to threadpattern 51. For example still, one end of set screw 50 may include athread pattern 51 and the other end may include an inset circumferentialsurface 54 having at least one flange 52 extending from an end thereof.In some embodiments, an upper and lower flange 52 are provided, and inother embodiments the flange 52 extends all the way around the end ofcircumferential surface 54 as an annular ring.

Implant 100 may include a proximal wedge structure 60 and a distal wedgestructure 70. Proximal wedge structure 60 may be operably coupled toproximal set screw 40 and distal wedge structure 70 may be operablycoupled to distal set screw 50, for example. Proximal wedge 60 mayinclude an aperture 61 having a size and shape corresponding tocircumferential surface 44. For example, set screw 40 may be coupled toproximal wedge 60 by disposing the circumferential surface 44 withinaperture 61 such that flanges 42 extend through aperture 61 and securelycouple the proximal wedge 60 with proximal set screw 40 such thatproximal set screw 40 may rotate within aperture 61. Additionally,flange 42 may permit axial translation of forces, for example by pushingand/or pulling. Proximal wedge 60 may further include a pair of superiorramped surfaces 63 and a pair of inferior ramped surfaces 64. Superiorramped surfaces 63 may be disposed on opposite lateral ends of proximalwedge 60 from one another and inferior ramped surface 64 may be disposedon opposite lateral ends of proximal wedge 60 from one another.Similarly, distal wedge structure 70 may include an aperture 71 having asize and shape corresponding to circumferential surface 54 of distal setscrew 50. For example, set screw 50 may be coupled to distal wedge 70 bydisposing the circumferential surface 54 within aperture 71 such thatflanges 52 extend through aperture 71 and securely couple the distalwedge 70 with distal set screw 50 such that distal set screw 50 mayrotate within aperture 71 and permit axial translation of forces. Distalwedge 70 may further include a pair of superior ramped surfaces 73 and apair of inferior ramped surfaces 74. Superior ramped surfaces 73 may bedisposed on opposite lateral ends of distal wedge 70 from one anotherand inferior ramped surfaces 74 may be disposed on opposite lateral endsof distal wedge 70 from one another.

Referring generally to FIGS. 7-8, there are various interior views of aninterior of a superior endplate 10 and referring generally to FIGS.9-10, there are various views of an interior of an inferior endplate.The proximal wedge 60 and distal wedge 70 may act against varioussurfaces of superior and inferior endplates 10, 20 to expand, contract,and incline implant 100 in various positions. For example, superiorendplate 10 may include a pair of proximal ramps 18 that are disposedproximate the proximal end of superior endplate 10 and are inclined froma medial position of superior endplate 10 towards the proximal end 100 pof implant 100, for example. In the disclosed embodiment, a firstproximal ramp 18 and a second proximal ramp 18 are disposed on oppositesides of superior engagement cutout 103 s. Additionally, superiorendplate 10 may include a pair of distal ramps 19 that are disposedproximate the distal end of superior endplate 10 and are inclined from amedial position of superior endplate 10 towards the distal end 100 d ofimplant 100. In the disclosed embodiment, a first distal ramp 19 and asecond distal ramp 19 are disposed on opposite sides of curvedindentation 16, for example.

Similarly, inferior endplate 20 may include a pair of proximal ramps 28that are disposed proximate the proximal end of inferior endplate 20 andare inclined from a medial position of inferior endplate 20 towards theproximal end 100 p of implant 100, for example. For example, inferiorendplate 20 may include a pair of proximal ramps 28 that are disposedproximate the proximal end of inferior endplate 20 and are inclined froma medial position of inferior endplate 20 towards the proximal end 100 pof implant 100, for example. In the disclosed embodiment, a firstproximal ramp 28 and a second proximal ramp 28 are disposed on oppositesides of inferior engagement cutout 103 i. Additionally, inferiorendplate 20 may include a pair of distal ramps 29 that are disposedproximate the distal end of inferior endplate 20 and are inclined from amedial position of inferior endplate 20 towards the distal end 100 d ofimplant 100. In the disclosed embodiment, a first distal ramp 29 and asecond distal ramp 29 are disposed on opposite sides of curvedindentation 26, for example. As will be explained in more detail below,superior ramped surfaces 63 of proximal wedge 60 may directly contactand act against proximal ramps 18 of superior endplate 10 and inferiorramped surfaces 64 of proximal wedge 60 may directly contact and actagainst proximal ramps 28 of inferior endplate 20. As will be explainedin more detail below, superior ramped surfaces 73 of distal wedge 70 maydirectly contact and act against distal ramps 19 of superior endplate 10and inferior ramped surfaces 74 of distal wedge 70 may directly contactand act against distal ramps 29 of inferior endplate 20.

Referring generally to FIGS. 11-16, there are various perspective viewsof an expandable implant 100 in a contracted position and in variousexpanded configurations. As shown in FIG. 11, superior endplate 10 isbi-concave. For example, superior endplate 10 is concave in theproximal-to-distal direction P-D along curved line 10-P-D and superiorendplate 10 is concave in the widthwise direction W-W along curved line10-W-W. This arrangement may be advantageous for mating with theconcavity of a lower surface of a superior endplate of an adjacentvertebrae (not illustrated), for example. Other embodiments may havesubstantially planar upper surfaces and/or be concave in only one of theproximal-to-distal direction P-D and widthwise direction W-W. Forexample, inferior endplate 20 may be uni-convex. As shown in FIG. 12,the inferior endplate 20 is convex in at least one direction. Forexample, inferior endplate is convex in a widthwise direction W-W alongcurved line 20-W-W. This arrangement may be advantageous for mating withthe concavity of an upper surface of an inferior endplate of an adjacentvertebrae (not illustrated). In some embodiments, the curvature of thesuperior endplate 10 and inferior endplate 20 may be lordotic relativeto one another. In some embodiments, the curvature of the superiorendplate 10 and inferior endplate 20 may have different amounts oflordosis relative to a central horizontal plane of support block 30, forexample.

FIG. 13 illustrates an example configuration of implant 100 in anexpanded and inclined position, e.g., a partially distracted andlordosed position. In FIGS. 13-14, it is illustrated that the proximalwedge 60 has moved towards the proximal end 100 p of implant 100 in theproximal-to-distal direction P-D, for example. Proximal wedge 60 mayhave moved towards the proximal end 100 p from a medial position due toproximal set screw 40 being rotated within proximal screw guide 31 psuch that proximal set screw 40 is linearly translated towards proximalend 100 p of implant 100. In doing so, proximal set screw 40 pushesproximal wedge 60 towards proximal end 100 p. Due to the inclination ofsuperior ramps 64 and inferior ramps 63, the superior and inferiorendplates 10, 20 are pushed apart at the proximal end 100 p. Forexample, superior ramps 64 may slide along proximal ramps 18 of superiorendplate 10 and inferior ramps 63 may slide along proximal ramps 28 ofinferior endplate 20. In this way, set screw 40 linearly translatesproximal wedge 60 such that superior and inferior ramps 64, 63 actagainst the superior and inferior endplates 10, 20 to urge them apartfrom one another at the proximal end 100 p of implant 100.

As shown in FIGS. 15-16, implant 100 may be distracted in a parallelmanner where the superior and inferior endplates 10, 20 aresubstantially parallel to one another and/or a height between superiorand inferior endplates 10, 20 is about the same at the proximal end 100p and distal end 100 d of implant 100, for example. The distal end 100 dof implant 100 may have been expanded as illustrated due to distal wedge70 being moved towards the distal end 100 d of implant 100 in theproximal-to-distal direction P-D, for example. Distal wedge 70 may havemoved towards the distal end 100 d from a medial position due to distalset screw 50 being rotated within distal screw guide 31 d such thatdistal set screw 50 is linearly translated towards distal end 100 d ofimplant 100. In doing so, distal set screw 50 pushes distal wedge 70towards distal end 100 d. Due to the inclination of superior ramps 74and inferior ramps 73, the superior and inferior endplates 10, 20 arepushed apart at the distal end 100 d. For example, superior ramps 74 mayslide along distal ramps 19 of superior endplate 10 and inferior ramps73 may slide along distal ramps 29 of inferior endplate 20. In this way,set screw 50 linearly translates distal wedge 70 such that superior andinferior ramps 74, 73 act against the superior and inferior endplates10, 20 to urge them apart from one another at the distal end 100 d ofimplant 100.

Referring generally to FIGS. 17-20, various cross section views of anexpandable implant 100 in a contracted configuration and an expandedconfiguration are shown. As shown in FIG. 17, implant 100 is in acontracted position and each of the proximal wedge 60 and distal wedge70 are in a medial position. Furthermore, posts 34, 33 of support block30 are engaged with the superior and inferior endplates 10, 20 byextending through slots 14, 23, respectively. As shown in FIG. 18, posts34, 33 of support block 30 have changed a relative position within slots14, 23 (relative to FIG. 17) to accommodate the increase in height atthe proximal end 100 p. For example, posts 34, 33 are fixed to supportblock 30 and the superior and inferior endplates 10, 20 may haveexpanded relative to support block 30 and therefore posts 34, 33 areshown in a different position relative to slots 14, 23. In FIG. 18,proximal wedge 60 may have moved towards the proximal end 100 p due toproximal set screw 40 being rotated and thereby pushing proximal wedge60 towards proximal end 100 p, for example. Additionally, superior ramps64 and inferior ramps 63, may act against the superior and inferiorendplates 10, 20 to push them apart. For example, superior ramps 64 mayslide along proximal ramps 18 of superior endplate 10 and inferior ramps63 may slide along proximal ramps 28 of inferior endplate 20. In thisway, set screw 40 linearly translates proximal wedge 60 towards proximalend 100 p such that superior and inferior ramps 64, 63 act against thesuperior and inferior endplates 10, 20 to urge them apart from oneanother. Additionally, in some embodiments lower proximal ramps 18 a maybe provided at the proximal end of superior endplate 10. Lower proximalramps 18 a may act as a catch surface such that when set screw 40 isrotated in the opposite direction a lower surface 63 a of superior ramps63 may push against lower proximal ramps 18 a to facilitate closing ofthe implant 100, for example.

FIG. 19 is a cross section drawing through line C-C of FIG. 2. As shownin FIG. 19, posts 34, 33 of support block 30 have changed a relativeposition within slots 14, 23 (relative to FIG. 18) to accommodate theincrease in height at the distal end 100 d. For example, post 34 hasmoved through slot 14 to a lower position and post 33 has moved to anupper position within slot 23. With reference back to FIG. 15, slots 14,23 extend in a lateral direction and posts 34, 14 are engaged withinslots 14, 23 throughout the full range of expansion (although it mayappear that in FIGS. 18-19 slot 14 is open at a bottom end this is dueto the section being drawn through line C-C of FIG. 2, for example). Inthis way, support block 30 may remain coupled to implant 100.Additionally, distal wedge 70 may have moved towards the distal end 100d due to distal set screw 50 pushing distal wedge 70 towards distal end100 d. Additionally, superior ramps 74 and inferior ramps 73 may actagainst the superior and inferior endplates 10, 20 and push them apartat the distal end 100 d. For example, set screw 50 linearly translatesdistal wedge 70 such that superior and inferior ramps 74, 73 act againstthe superior and inferior endplates 10, 20 to urge them apart from oneanother at the distal end 100 d of implant 100. In some embodiments,upper distal ramps 29 a may act as a catch surface such that when setscrew 50 is rotated in the opposite direction an upper surface 74 a ofinferior ramps 74 may push against upper distal ramps 29 a to facilitateclosing of the implant 100, for example. For example, as shown in FIG.20, a height between the superior and inferior endplates 10, 20 atdistal end 100 d is less than a height between the superior and inferiorendplates 10, 20 at distal end 100 d of FIG. 19. This may occur due todistal wedge 70 being moved in the proximal-to-distal direction towardsa medial position of implant and upper distal ramps 29 a acting as acatch surface as explained above, for example. Those with skill in theart will appreciate that implant 100 is continuously adjustable at anylevel of distraction and/or lordosis between the fully collapsedposition (see FIG. 17) and a fully expanded position (see FIG. 19).

Referring generally to FIGS. 21-28B various views of an inserter tool200 and a drive tool 300 for use with disclosed expandable implants 100are shown. Inserter tool 200 may extend from a proximal end to distalend and include a hollow outer shaft 201 and a hollow inner shaft 203.The hollow outer shaft 201 may include support walls 207 at a distal endthereof having a size and shape close the flexible tip of shaft 203. Forexample, seam 203 s may enable the distil end of shaft 203 to becompressed together when shaft 203 is insert within outer shaft 201 suchthat engagement arms 204 are moved closer together. Hollow outer shaft201 may include a gripping handle 202 extending therefrom and in variousembodiments, gripping handle 202 may be a stationary handle or a movablehandle (not illustrated). Additionally, hollow inner shaft 203 mayinclude engagement arms 204 at a distal end thereof, for example.Engagement arms 204 may be used to grip implant 100 at engagement prongs32, for example (see FIGS. 24A and 24B). Additionally, engagement arms204 may have a size and shape generally corresponding to a size andshape of engagement prongs 32. For example, engagement arms 204 maysurround (or at least partially surround) engagement prongs 32 andsecurely grip engagement prongs 32 such that implant 100 may be retainedby inserter tool 200 and inserted into a disc space. In variousembodiments, engagement arms 204 may have outdents and/or protrusionsthat engage corresponding grooves and/or recesses of engagement prongs32 (not illustrated). Inserter tool 200 may include a hollow outer shaft201 and a hollow inner shaft 203. As shown in FIG. 22, hollow innershaft 203 may be inserted within and disposed within hollow outer shaft201, for example. Hollow inner shaft 203 may include a threaded end 205at a proximal end thereof. Threaded end 205 may extend beyond theproximal end of hollow outer shaft 201 such that a coupling member 206having an internal thread pattern corresponding to the threaded end 205may be attached to a proximal end of hollow inner shaft 203. Oncecoupling member 206 is sufficiently tightened the hollow outer shaft 201and hollow inner shaft 203 may be securely coupled. Additionally, ascoupling member 206 is rotated, the inner shaft 203 is pulled deeperwithin outer shaft 205 such that a compressive force may be applied atthe engagement arms 204 via interior surfaces of support walls 207thereby providing a strong clamping force around engagement prongs 32 ofimplant 100 (see FIGS. 21-25).

Once the coupling member 206 is sufficiently tightened such thatengagement arms 204 are secured to engagement prongs 32, a drive tool300 may be inserted through an aperture of coupling member 206 and intothe hollow interior of inner shaft 203 (see FIG. 26). Drive tool 300 mayextend in a proximal to distal direction and include a handle 302 at aproximal end and a drive end 301 at a distal end, for example.Additionally, drive tool 300 may include a first circumferential channel303 and a second circumferential channel 304 that may be indented alongan outside surface of drive tool 300. In the example, embodiment, adepressible lock 207 of coupling member 206 may selectively engage anddisengage with either one of the first circumferential channel 303 and asecond circumferential channel 304 to position drive tool 300 atrelative axially aligned positions within the interior of hollowinterior shaft 203. For example, as shown in FIG. 28A depressible lock207 is disengaged and as shown in FIG. 28B depressible lock 207 isdepressed such that an indent or the like may b retained circumferentialchannels 303 or 304. A relative distance between the firstcircumferential channel 303 and a second circumferential channel 304 maycorrespond to a distance between the proximal set screw 40 and distalset screw 50, for example.

In this way, toggling between engaging the depressible lock 207 witheither one of the first and second circumferential channels 303, 304 mayaffect whether drive end 301 engages with both the distal set screw 50and proximal set screw 40 or alternatively just the proximal set screw40, for example. As shown in FIG. 29, the depressible lock 207 may beengaged with the second circumferential channel 304 such that drive end301 may simultaneously drive both the distal set screw 50 and proximalset screw 40. As shown in FIG. 30, the depressible lock 207 may beengaged with the first circumferential channel 303 such that drive end301 is only engaged with the proximal set screw 40. At least oneadvantage of this configuration is that an end user such as a surgeonmay simultaneously rotate the proximal and distal set screws 40, 50 tocause parallel distraction or rotate only the proximal set screw 40 tocause lordosis.

FIG. 31 illustrates an alternate drive tool 300 a. Alternate drive tool300 a may include the same, substantially the same, and or similarcharacteristics as explained above with respect to drive tool 300.However, alternate drive tool 300 a may include a necked down portion305 and a drive end 301 a having a size and shape suitable for onlyengaging one of the proximal set screw 40 or distal set screw 50 at atime. For example, the necked down portion 305 may have a smaller crosssectional diameter (thickness) than the drive end 301 a. Thisarrangement may be particularly advantageous for engaging only thedistal set screw 50 to change a relative height between the superior andinferior endplates 10, 20 at the distal end 100 d only, for example. Asshown in FIG. 32, drive end 301 a is only engaged with the distal setscrew 50 and the necked down portion 305 is narrow enough such that itdoes not contact the interior circumferential surface of set screw 40,for example. Similarly, this arrangement may be particularlyadvantageous for engaging only the proximal set screw 40 to change arelative height between the superior and inferior endplates 10, 20 atthe proximal end 100 p only, for example. Furthermore, when engagingonly distal set screw 50, a relative height between the superior andinferior endplates 10, 20 at the distal end 100 d may be changed, forexample to create kyphosis.

In some embodiments, after implant 100 is expanded into a targetconfiguration suitable for a particular patient, bone graft material(BGM) may be injected into implant 100. For example, flowable bone graftmaterial may be injected under pressure. For example, as shown in FIG.33, the drive tool 300 (or alternate drive tool 300 a) may be removedfrom within the hollow interior of inner shaft 203. Thereafter, bonegrowth promoting material may be injected through the hollow interior ofinner shaft 203 and into the interior of implant 100. For example, bonegrowth promoting material may flow through shaft 203, through set screw40, through a central cavity of block support block 30 and into contactwith the endplates of adjacent vertebrae. Additionally, lateral holesbetween posts 34, 33 of support block 30 may allow additional bonegrowth promoting material to flow out in a lateral direction and intothe interior of implant 100 and to surround wedges 60, 70. In this way,the entire interior space of implant 100 may be filled with bone growthpromoting material to promote fusion. In some embodiments, flexiblecurtains (not illustrated) may extend from superior endplate 10 and/orinferior endplate 20 across gaps that may be created between endplates10, 20 due to expanding the endplates. In some embodiments, a distalmost end of distal set screw 50 may also be closed to prevent materialfrom flowing out of distal set screw 50. Additionally, and depending onthe type of surgery performed and the various patient anatomy that maycontact the implant 100, curtains may not be required, as the patientanatomy would provide a retaining surface to keep material withinimplant 100.

FIG. 34 is a reference drawing showing the human spine of which variousdisclosed implant embodiments may be installed in. FIG. 35 is areference drawing showing various planes and reference directions ofwhich the various disclosed implant embodiments may move in or act inwith reference to a patient 1.

Referring generally to FIGS. 36-40, various views of an expandableimplant 400 having eyelets 82, 84 is disclosed. Implant 400 may includethe same, similar, and/or substantially the same components andfunctionality as implant 100. For example, implant 400 may include thesame, similar, and/or substantially the same moving mechanism as implant100 (see FIGS. 5-6). Additionally implant 400 may utilize the insertertool 200 and drive tool 300 in the same, similar, and/or substantiallythe same manner as explained above. Furthermore, implant 400 may includesimilar geometric attributes such as curvature (see FIGS. 11, 12) and/orcutouts 11, 21, 16, 26 (see FIGS. 1A, 1B, and 3).

In various embodiments, implant 400 may include at least one eyelet 82,84. In some embodiments, eyelets 82, 84 may be referred to as aperturesand/or lumens and may be shaped to orient and support a bone screw 90along a corresponding target trajectory, for example. In the exampleembodiment, superior endplate 10 may include an eyelet 82 disposed on aproximal side 100 p at a farthest lateral end 1001 thereof, e.g., thefront right corner when viewed from the perspective of FIG. 36.Additionally, superior endplate 10 may include a superior aperture 83 ina superior endplate surface such that a bone screw 90 may pass througheyelet 82 and superior aperture 83. In various embodiments, eyelet 82may take a circular and/or conical shape and include a rim 82 a whichmay serve as a stop feature for a head 91 of a bone screw 90, forexample. In this way, rim 82 a may securely orient a bone screw 90 in atarget trajectory. In various embodiments, rim 82 a may be continuousaround the inside of eyelet 82 and in other embodiments rim 82 a may bediscontinuous, for example to accommodate lateral cutouts in the sideportions of eyelet 82 and/or other geometric features. It shall beunderstood that eyelets 84 and 82 may include the same, similar, and/orsubstantially the same features although some attributes of eyelets 82,84 may not be fully visible from the various orientations shown in thedrawings. Accordingly, where one eyelet 82, 84 illustrates a feature itshall be understood the other eyelet 82, 84 may include the samefeature.

Inferior endplate 20 may include an eyelet 84 disposed on a proximalside 100 p at a farthest lateral end 100 l thereof, e.g., the front leftcorner when viewed from the perspective of FIG. 36. Inferior endplate 20may include an inferior aperture 85 in an outermost surface thereof suchthat a bone screw 90 may pass through eyelet 84 and inferior aperture85. In various embodiments, eyelet 84 may take a circular and/or conicalshape and include a rim 84 a which may serve as a stop feature for ahead 91 of a bone screw 90, for example. In this way, rim 84 a maysecurely orient a bone screw 90 in a target trajectory. In variousembodiments, rim 84 a may be continuous around the inside of eyelet 84and in other embodiments rim 84 a may be discontinuous, for example toaccommodate lateral cutouts in the side portions of eyelet 84 and/orother geometric features.

As shown in FIGS. 39A and 39B, eyelets 82, 84 may orient a bone screw 90in a target trajectory. Eyelet 82 may orient a bone screw 90 in firsttarget trajectory 93, e.g., a superior direction along a lateral-tomedial trajectory. As shown in FIGS. 39A and 39B, eyelets 82, 84 mayorient a corresponding bone screw in a lateral-to-medial direction. Forexample, as seen in the plan view of FIG. 39B, the first targettrajectory 93 extends in a lateral-to-medial trajectory across the topsurface (outside surface) of superior endplate 10. Similarly, eyelet 84may orient a bone screw 90 in a second target trajectory 94, e.g., aninferior direction along a lateral-to medial trajectory. As shown inFIG. 39B, in a plan view the second target trajectory 94 extends in alateral-to-medial trajectory underneath the bottom surface (outsidesurface) of inferior endplate 20. At least one advantage of thislateral-to-medial trajectory is that each eyelet 82, 84 may allow arelatively great acute angle-of-incidence with a corresponding boneymember, such as a superior and inferior vertebrae, for example. Thisorientation provides a relatively greater anchoring force because theassociated force to pull the bone screw out may be greater because theassociated forces are more perpendicular to the corresponding bonescrews 90. As shown in FIG. 39B, in various embodiments an internalangle of trajectory 93 (and trajectory 94) may be about 20 degrees toabout 30 degrees with respect to the longitudinal axis, for example. Insome embodiments, the internal angle may be about 25 degrees.

Additionally, in various embodiments the eyelets 82, 84 protrudelaterally to a corresponding side farther than the remaining lateralsides of implant 400 in the medial and distal portions. For example, inthe plan view shown in FIG. 39B, eyelet 82 is disposed on a farthestlateral edge from a central longitudinal axis extending in the proximalto distal direction P-D through a center of implant 400. Similarly,eyelet 84 is disposed on a farthest lateral edge from a centrallongitudinal axis extending in the proximal to distal P-D directionthrough a center of implant 400. As shown in FIG. 40, implant 400 isinstalled between a superior vertebrae and an inferior vertebrae andeach bone screw 90 extends in a lateral-to-medial trajectory.

Referring generally to FIGS. 41-42 a bone screw driver 500 isillustrated. FIGS. 43A, 43B, 43C, and 43D illustrate an installationsequence utilizing a bone screw driver 500 and an expandable implant400. In various embodiments, bone screw driver 500 may include a handle501 that extends in a proximal to distal direction and is securelycoupled to a driving tip 502. Those with skill in the art willappreciate that al enght of handle 501 may directly correspond to anultimate force (torque) provided at driving tip 502. Driving tip 502 mayextend in a perpendicular direction relative to an extension directionof handle 501, for example. In the illustrated embodiment, driving tip502 extends away from handle 501 at about 90 degrees. However, in otherembodiments, driving tip 502 may be angled at about 60 degrees, and inother embodiments driving tip maybe angled at about 45 degrees. It shallbe understood that driving tip 502 may be angled relative to handle 501at any angle within a range of about 45 degrees to about 90 degrees, forexample. At least one advantage of an angled driving tip 502 may be thatit facilitates driving bone screws 90 in the target trajectory insituations where space may be limited. For example, space may be limitedwhen installing bone screws 90 due to incision size, the particularlocation of implant 400 in the human body, and/or the relatively greatangle of repose eyelets 82, 84 accommodate. Additionally, thelateral-to-medial trajectory may make it difficult for other drivers tobe able to access the head portion 91 at this angle. However, a straighthead drive tool, such as drive tool 300 shown in FIG. 31 may be used insome situations.

As shown in FIG. 42, a removed parts view of a proximal end of bonescrew driver 500 is illustrated. In the example embodiment, it is shownthat an interior of driver tip 502 includes a toothed ratchet 504 (mayalso be referred to as a toothed gear) that is in contact with pawl 503.Pawl 503 may be biased towards ratchet 504 by a coil spring 506, forexample. Pawl 503 allow ratchet 504 (and driver tip 502) to rotate in asingle direction when it is engaged and prevent rotation in the oppositedirection. In the example configuration and from the particularperspective shown in FIG. 42, as the ratchet rotates clockwise, theteeth of ratchet 504 may lift or move the pawl out of the way, allowingthe driver handle 501 to be rotated without transferring a rotationforce to driver tip 502. This may allow an end user such as a surgeon toreset a position of handle 501 to perform an additional drive rotationwithout requiring the drive tip 502 to be uncoupled from the headportion 91 of a bone screw 90, for example. Conversely, as the ratchetspins counter-clockwise, the pawl 503 binds against the ratchet andprevents its rotation thereby transferring the rotational force of thehandle 501 through to the driving tip 502. In some embodiments, pawl 506may slide forward and backward in a proximal-to-distal direction along adovetail shaped track that prevents it from slipping out in a lateraldirection while also allowing it to slide forward and backward in theproximal-to-distal direction, for example.

In FIG. 43A an implant 400 may be positioned beneath a superiorvertebrae and in FIG. 43B bone screw driver 500 may be rotated clockwise(to the right in the perspective view of FIG. 43B) to tighten the bonescrew 90 within the superior vertebrae, for example. As the bone screwdriver 500 is rotated clockwise, the pawl 503 may bind against ratchet504 thereby transmitting the full rotational force from handle 501 todrive end 502 as explained above. Thereafter, as shown in FIG. 43C thebone screw driver 500 may be rotated counter-clockwise (to the left inthe perspective view of FIG. 43C). As the bone screw driver 500 isrotated counter-clockwise the pawl 503 may disengage from ratchet 504thereby preventing the rotational force from handle 501 to drive end 502as explained above. Thereafter, as shown in FIG. 43D, the bone screwdriver 500 is rotated clockwise again, thereby continuing to drive thebone screw 90 farther into the superior vertebrae. Once the bone screw90 is driven to a target depth, an end user may reposition bone screwdriver 500 to finish driving the other bone screw 90 into the inferiorvertebrae, for example.

Referring generally to FIGS. 44-50, a modular bone screw endplate 600for use with various implants 100, 400 disclosed herein is illustrated.As shown in FIG. 44 a bone screw endplate 600 including four bone screwapertures 601 is illustrated. Bone screw endplate 600 may include aretaining pin 620 which may facilitate securely coupling to anduncoupling from implant 400, as will be explained in further detailbelow. Bone screw endplate 600 may include a rotatable lock 610 whichmay be rotated clockwise and/or counterclockwise to block various bonescrews 90 when installed into a final position through bone screwaperture 601, for example. As shown in the top down view of FIG. 46,bone screw endplate 600 may be curved and include a the same, similar,and/or substantially the same curvature as the proximal end of implant400, for example. Accordingly, the curvature of implant 400 wontrestrict securing the bone screw endplate 600 to the implant 400 andvice-versa. Bone screw endplate may further include other geometricindentations to accommodate eyelets 82, 84. For example, a profile ofcurvature of the medial section may include an eyelet profile portion630 at a region corresponding to a location of eyelets 82, 84. Invarious embodiments, eyelet profile portions 630 directly contacteyelets 82, 84 and have various mating features. In other embodiments,eyelet profile portions 630 may snuggly fit against eyelets 82, 84 andfacilitate a secure connection between implant 400 and bone screwendplate 600 by providing a counter torque surface to prevent rotationof bone screw endplate 600.

FIG. 47 illustrates an exploded parts view of bone screw endplate 600.In the example embodiment, it is shown that locking wheel 610 includes adrive engagement aperture 611 for rotating the locking wheel 610, forexample. In the example embodiment, locking wheel 610 includes fourlocking arms 612 which correspond in number to the four bone screwapertures 601. Additionally, locking arms 612 correspond in length to adistance from central aperture 614 to about a center of bone screw head91. In this way, as the locking wheel 610 is rotated it may preventand/or suppress the bone screws 90 from backing out by blocking them onthe proximal side of implant 400, for example. In some embodiments, asmall gap may exist between the distal side of locking arms 612 (rearside from the perspective of FIG. 47) and the head 91 of a bone screwwhen it is fully installed. In other embodiments, the locking arms 612may directly contact a head 91 of a corresponding bone screw 90 when itis fully installed. In the example embodiment, retaining pin 620 may besecurely positioned in retaining pin cavity 621 which may enable bonescrew endplate 600 to securely couple to implant 400 between theinferior engagement cutout 103 i and superior engagement cutout 103 sadjacent engagement prongs 32, for example (see FIG. 36).

FIG. 48 illustrates a perspective view of a fully assembled implantsystem including an implant 400 having eyelets 82, 84 and a bone screwendplate 600 coupled thereto. FIG. 49 illustrates a front view of thefully assembled implant system. In the front view it is shown that driveengagement aperture 611 is coaxially aligned with aperture 614 thereforeallowing a drive tool, such as the drive tool 300 illustrated in FIG. 31to adjust a kyphotic and/or lordotic angle of implant 400 by actuationof set screw 40 and 50 (see FIG. 5) as explained previously. In thisway, an end user such as a surgeon may continue to adjust the kypoticand/or lordotic angle of implant 400 if needed, for example.

It should be understood that various aspects disclosed herein may becombined in different combinations than the combinations specificallypresented in the description and accompanying drawings. For example,features, functionality, and components from one embodiment may becombined with another embodiment and vice versa unless the contextclearly indicates otherwise. Similarly, features, functionality, andcomponents may be omitted unless the context clearly indicatesotherwise. It should also be understood that, depending on the example,certain acts or events of any of the processes or methods describedherein may be performed in a different sequence, may be added, merged,or left out altogether (e.g., all described acts or events may not benecessary to carry out the techniques).

Unless otherwise specifically defined herein, all terms are to be giventheir broadest possible interpretation including meanings implied fromthe specification as well as meanings understood by those skilled in theart and/or as defined in dictionaries, treatises, etc. It must also benoted that, as used in the specification and the appended claims, thesingular forms “a,” “an” and “the” include plural referents unlessotherwise specified, and that the terms “comprises” and/ or“comprising,” when used in this specification, specify the presence ofstated features, elements, and/or components, but do not preclude thepresence or addition of one or more other features, steps, operations,elements, components, and/or groups thereof.

What is claimed is:
 1. An expandable implant movable between acontracted position and an expanded position, comprising: an expandablebody having a longitudinal axis extending through a center of theexpandable body from a proximal end to a distal end in aproximal-to-distal direction, the expandable body extending from a firstlateral side to a second lateral side in a widthwise direction, andextending from a superior end to an inferior end in a verticaldirection; a superior endplate including a first outside surface and afirst inside surface opposite the first outside surface, the firstinside surface including first proximal ramps and first distal rampsdisposed opposite the first proximal ramps; an inferior endplateincluding a second outside surface and a second inside surface oppositethe second outside surface, the second inside surface including secondproximal ramps and second distal ramps disposed opposite the secondproximal ramps; a support block coupled to the superior endplate and theinferior endplate, the support block having a proximal screw guide and adistal screw guide opposite the proximal screw guide, a proximal setscrew rotatably supported by the proximal screw guide and a distal setscrew rotatably supported by the distal screw guide; a proximal wedgeincluding first superior ramped surfaces and first inferior rampedsurfaces, the proximal wedge being coupled to the proximal set screw; adistal wedge including second superior ramped surfaces and secondinferior ramped surfaces, the distal wedge being coupled to the distalset screw; and at least one eyelet disposed on a proximal end of theexpandable body; wherein: in a contracted position the proximal wedgeand the distal wedge are disposed in a medial position of the body, in afirst expanded position a spacing between the superior and inferiorendplates at the proximal side is greater than a spacing between thesuperior and inferior endplates at the proximal side in the contractedposition, in the first expanded position the proximal wedge contacts thefirst superior ramped surfaces and the first inferior ramped surfacesand is disposed proximate the proximal side, and in a second expandedposition a spacing between the superior and inferior endplates at thedistal side is greater than a spacing between the superior and inferiorendplates at the distal side in the contracted position, in the secondexpanded position the distal wedge contacts the first and secondproximal ramps and is disposed proximate the proximal side with respectto the medial position.
 2. The expandable implant of claim 1, whereinthe at least one eyelet comprises a first eyelet and a second eyelet,the superior endplate comprises the first eyelet, and the inferiorendplate comprises the second eyelet.
 3. The expandable implant of claim2, wherein the first eyelet is disposed adjacent the first lateral sideand configured to support a first bone screw in a first targettrajectory and the second eyelet is disposed adjacent the second lateralside and configured to support a second bone screw in a second targettrajectory.
 4. The expandable implant of claim 2, wherein: the superiorendplate comprises a first bone screw aperture that is coaxially alignedwith the first target trajectory and the inferior endplate comprises asecond bone screw aperture that is coaxially aligned with the secondtarget trajectory.
 5. The expandable implant of claim 3, wherein: thefirst target trajectory comprises a first internal angle measuredbetween the first target trajectory and the longitudinal axis; thesecond target trajectory comprises a second internal angle measuredbetween the second target trajectory and the longitudinal axis; and thefirst internal angle and the second internal angle are within a range ofabout 20 degrees to about 30 degrees.
 6. The expandable implant of claim1, further comprising a bone screw endplate configured to couple to theproximal end of the expandable body.
 7. The expandable implant of claim1, further comprising: a bone screw endplate, wherein: the at least oneeyelet comprises a first eyelet and a second eyelet, the first eyelet,the superior endplate comprises the first eyelet, and the inferiorendplate comprises the second eyelet, and the bone screw endplate isdisposed between and contacts the first eyelet and second eyelet.
 8. Theexpandable implant of claim 7, wherein: the bone screw endplatecomprises a plurality of bone screw apertures and a rotatable lockingwheel having a plurality of locking arms, and in a locked position, alocking arm of the plurality of locking arms blocks a corresponding bonescrew aperture of the plurality of bone screw apertures of the bonescrew endplate.
 9. The expandable implant of claim 8, wherein therotatable locking wheel comprises a drive aperture that is coaxiallyaligned with the proximal set screw and the distal set screw.
 10. Theexpandable implant of claim 7, wherein the bone screw endplate issecurely coupled to the expandable body at a superior engagement cutoutregion and an inferior engagement cutout region.
 11. The expandableimplant of claim 7, wherein the bone screw endplate is securely coupledto the expandable body via a retaining pin.
 12. The expandable spinalimplant of claim 7, wherein the proximal end of the expandable body isconcave in the widthwise direction and the bone screw endplate iscontoured to the concavity of the expandable body in the widthwisedirection.
 13. The expandable implant of claim 1, wherein the at leastone eyelet comprises a corresponding rim disposed on an internal surfacethereof, the rim having a circumferential profile.
 14. An expandablespinal implant system, comprising: an expandable implant and a bonescrew driving tool, the expandable implant being movable between acontracted position and an expanded position and comprising: anexpandable body having a longitudinal axis extending through a center ofthe expandable body from a proximal end to a distal end in aproximal-to-distal direction, the expandable body extending from a firstlateral side to a second lateral side in a widthwise direction, andextending from a superior end to an inferior end in a verticaldirection; a superior endplate including a first outside surface and afirst inside surface opposite the first outside surface, the firstinside surface including first proximal ramps and first distal rampsdisposed opposite the first proximal ramps; an inferior endplateincluding a second outside surface and a second inside surface oppositethe second outside surface, the second inside surface including secondproximal ramps and second distal ramps disposed opposite the secondproximal ramps; a support block coupled to the superior endplate and theinferior endplate, the support block having a proximal screw guide and adistal screw guide opposite the proximal screw guide, a proximal setscrew rotatably supported by the proximal screw guide and a distal setscrew rotatably supported by the distal screw guide; a proximal wedgeincluding first superior ramped surfaces and first inferior rampedsurfaces, the proximal wedge being coupled to the proximal set screw; adistal wedge including second superior ramped surfaces and secondinferior ramped surfaces, the distal wedge being coupled to the distalset screw; and at least one eyelet disposed on a proximal end of theexpandable body; wherein: in a contracted position the proximal wedgeand the distal wedge are disposed in a medial position of the body, in afirst expanded position a spacing between the superior and inferiorendplates at the proximal side is greater than a spacing between thesuperior and inferior endplates at the proximal side in the contractedposition, in the first expanded position the proximal wedge contacts thefirst superior ramped surfaces and the first inferior ramped surfacesand is disposed proximate the proximal side, and in a second expandedposition a spacing between the superior and inferior endplates at thedistal side is greater than a spacing between the superior and inferiorendplates at the distal side in the contracted position, in the secondexpanded position the distal wedge contacts the first and secondproximal ramps and is disposed proximate the proximal side with respectto the medial position; and the system further comprises a bone screwdriver comprising a handle portion and a drive portion disposed at adistal end of the handle portion, the drive portion further including aratcheting mechanism.
 15. The expandable spinal implant system of 14,wherein the at least one eyelet comprises a first eyelet and a secondeyelet, the first eyelet disposed on the superior endplate and thesecond eyelet disposed on the inferior endplate.
 16. The expandablespinal implant system of claim 15, wherein the first eyelet is disposedadjacent the first lateral side and configured to support a first bonescrew in a first target trajectory and the second eyelet is disposedadjacent the second lateral side and configured to support a second bonescrew in a second target trajectory.
 17. The expandable spinal implantsystem of claim 15, further comprising a bone screw endplate, wherein:the bone screw endplate comprises a plurality of bone screw aperturesand a rotatable locking wheel having a plurality of locking arms, and ina locked position, a locking arm of the plurality of locking arms blocksa corresponding bone screw aperture of the plurality of bone screwapertures of the bone screw endplate.
 18. The expandable spinal implantof claim 14, further comprising: an insertion tool, wherein the supportblock further comprises at least one engagement prong extending towardsthe proximal end in the proximal-to-distal direction, and wherein theinsertion tool comprises: a hollow outer shaft and a hollow inner shaftdisposable within the hollow outer shaft; and at least one engagementarm having a size and shape corresponding to the at least one engagementprong.
 19. The spinal implant system of claim 18, further comprising: afirst set screw driving tool disposable within the hollow interior shaftand having a drive end having a first cross sectional diameter and anecked down portion having a second cross sectional diameter, the firstcross sectional diameter being greater than the second cross sectionaldiameter, wherein the first set screw driving tool is extendable in thelongitudinal direction through the hollow interior shaft such that thedrive end is engageable with either one of the proximal set screw ordistal set screw.
 20. The spinal implant system of claim 19, furthercomprising: a second set screw driving tool disposable within the hollowinterior shaft and having a drive end, wherein the second set screwdriving tool is extendable in the longitudinal direction through thehollow interior shaft such the drive end is engageable with both of theproximal set screw and distal set screw.